不同微创路径下食管癌根治术的临床疗效分析

doi:10.3969/j.issn.1674-8115.2026.08.009

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (8): 1091-1100.doi: 10.3969/j.issn.1674-8115.2026.08.009

• 论著 · 临床研究 • 上一篇

不同微创路径下食管癌根治术的临床疗效分析

袁婉迪¹, 朱紫茵², 赵祖源³, 姚舒桓², 孙香², 韦海涛⁴, 李丽²^,⁴(), 李敏惠⁵

^1.河南中医药大学第一附属医院胸外科，郑州 450002
^2.河南大学护理与健康学院，开封 475001
^3.成都医学院临床医学院，成都 610500
^4.河南大学淮河医院胸外科，开封 475001
^5.成都医学院科技处科研实验中心，成都 610500

收稿日期:2026-02-24 接受日期:2026-05-26 出版日期:2026-08-13 发布日期:2026-08-13
通讯作者: 李丽，教授，博士；电子信箱：10210051@vip.henu.edu.cn。
作者简介:第一联系人：袁婉迪和朱紫茵负责论文撰写，赵祖源、姚舒桓、孙香负责数据收集、整理及统计分析，韦海涛负责手术相关审核，李丽和李敏惠负责论文的审核及指导。所有作者均阅读并同意了最终稿件的提交。
基金资助:
河南省高等学校重点科研项目(26B320003);河南省高等学校重点科研项目(26A320002);河南省高等学校重点科研项目(26A320004);河南省科技厅科技攻关资助项目(262102310203);河南省科技厅科技攻关资助项目(262102310196);河南省科技厅科技攻关资助项目(262102310195)

Analysis of clinical efficacy of radical esophagectomy for esophageal cancer using different minimally invasive approaches

Yuan Wandi¹, Zhu Ziyin², Zhao Zuyuan³, Yao Shuhuan², Sun Xiang², Wei Haitao⁴, Li Li²^,⁴(), Li Minhui⁵

^1.Department of Thoracic Surgery, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450002, China
^2.School of Nursing and Health, Henan University, Kaifeng 475001, China
^3.School of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China
^4.Department of Thoracic Surgery, Huaihe Hospital of Henan University, Kaifeng 475001, China
^5.Scientific Research and Experiment Center, Division of Science and Technology, Chengdu Medical College, Chengdu 610500, China

Received:2026-02-24 Accepted:2026-05-26 Online:2026-08-13 Published:2026-08-13
Contact: Li Li，E-mail:10210051@vip.henu.edu.cn.
About author:First author contact:Yuan Wandi and Zhu Ziyin were responsible for drafting the manuscript. Zhao Zuyuan, Yao Shuhuan, and Sun Xiang were responsible for data collection, organization, and statistical analysis. Wei Haitao was responsible for the review of surgery-related content. Li Li and Li Minhui were responsible for the review and supervision of the manuscript. All authors have read and approved the final version of the manuscript.
Supported by:
Key Scientific Research Project of Higher Education Institutions in Henan Province(26B320003);Science and Technology Research Project of Henan Provincial Department of Science and Technology(262102310203)

摘要/Abstract

摘要：

目的·评估并比较3种食管癌根治术的疗效。方法·回顾性分析接受食管癌根治术的298例患者的临床资料，按手术方式分为充气式纵隔镜同步腹腔镜食管癌根治术（synchronous insufflation mediastinoscopy with laparoscopic esophagectomy，SIMLE）组、纵隔镜联合腹腔镜食管癌切除术（combined insufflation mediastinoscopy-laparoscopy esophagectomy，CIMLE）组和McKeown术组，采用倾向性评分匹配（propensity score matching，PSM）法以1∶1比例进行分层两两匹配。分析各组术前基线资料、手术时间、术中出血量、内环境稳态指标、术后并发症、淋巴结清扫数量、术后恢复情况等差异。结果·经PSM，SIMLE组与CIMLE组匹配75对，SIMLE组与McKeown组匹配88对。SIMLE组手术时间和术中出血量均显著低于CIMLE组和McKeown组（均P<0.001）。麻醉诱导结束时，SIMLE组血糖、酸碱度、剩余碱、乳酸水平均优于CIMLE组和McKeown组（均P<0.05）。SIMLE组术后吻合口瘘和吻合口狭窄等并发症的发生率低于CIMLE组和McKeown组（均P<0.05），术后住院时间也短于CIMLE及McKeown组（均P<0.001）。术后7 d，SIMLE组白细胞介素-6、肿瘤坏死因子-α、C反应蛋白水平均显著低于CIMLE组和McKeown 组（均P<0.05）。术后14 d，SIMLE组前白蛋白、白蛋白水平恢复更佳（均P<0.05）。术后1个月内，SIMLE组15项恢复质量评分量表的评分显著高于CIMLE组和McKeown组（均P<0.05）。结论·SIMLE术式通过纵隔镜与腹腔镜同步操作，可缩短手术时间，减少创伤应激，加速术后恢复，为食管癌患者提供了新的微创治疗选择。

关键词: 充气式纵隔镜同步腹腔镜食管癌根治术, 纵隔镜联合腹腔镜食管癌切除术, McKeown术, 食管癌根治术, 临床疗效

Abstract:

Objective ·To evaluate and compare the efficacy of three types of radical esophagectomy for esophageal cancer. Methods ·The clinical data of 298 patients who underwent radical esophagectomy were retrospectively analyzed. The patients were divided into three groups based on the surgical approach: the synchronous insufflation mediastinoscopy with laparoscopy esophagectomy (SIMLE) group, the combined insufflation mediastinoscopy-laparoscopy esophagectomy (CIMLE) group, and the McKeown group. Propensity score matching (PSM) was performed at a 1∶1 ratio for pairwise stratification matching between groups. Differences among the groups were analyzed in terms of preoperative baseline data, operative time, intraoperative blood loss, indicators of internal homeostasis, postoperative complications, number of lymph nodes dissected, and postoperative recovery status. Results ·After PSM, 75 pairs were matched between the SIMLE and CIMLE groups, and 88 pairs between the SIMLE and McKeown groups. Operative time and intraoperative blood loss in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups (all P<0.001). At the end of anesthesia induction, indicators of internal homeostasis, including pH value, glucose, base excess, and lactate levels, in the SIMLE group were superior to those in the CIMLE and McKeown groups (all P<0.05). The SIMLE group also showed better outcomes than the other two groups in terms of complications such as anastomotic leakage and anastomotic stricture (P<0.05). The postoperative hospital stay in the SIMLE group was shorter than that in the CIMLE and McKeown groups (both P<0.001). At 7 days postoperatively, levels of interleukin-6, tumor necrosis factor-ɑ, and C-reactive protein in the SIMLE group were significantly lower than those in the CIMLE and McKeown groups (all P<0.05). At 14 days postoperatively, recovery of prealbumin and albumin levels was better in the SIMLE group (all P<0.05). Within 1 month after surgery, the SIMLE group had significantly higher scores on the 15-item Quality of Recovery-15 (QoR-15) scale compared to the CIMLE and McKeown groups (all P<0.05). Conclusion ·The SIMLE procedure, through synchronous operation using mediastinoscopy and laparoscopy, can shorten operative time, reduce surgical stress, and accelerate postoperative recovery, providing a new minimally invasive treatment option for patients with esophageal cancer.

Key words: synchronous insufflation mediastinoscopy with laparoscopic esophagectomy (SIMLE), combined insufflation mediastinoscopy-laparoscopy esophagectomy (CIMLE), McKeown esophagectomy, radical esophagectomy for esophageal cancer, clinical efficacy

中图分类号:

R735.1

袁婉迪, 朱紫茵, 赵祖源, 姚舒桓, 孙香, 韦海涛, 李丽, 李敏惠. 不同微创路径下食管癌根治术的临床疗效分析[J]. 上海交通大学学报（医学版）, 2026, 46(8): 1091-1100.

Yuan Wandi, Zhu Ziyin, Zhao Zuyuan, Yao Shuhuan, Sun Xiang, Wei Haitao, Li Li, Li Minhui. Analysis of clinical efficacy of radical esophagectomy for esophageal cancer using different minimally invasive approaches[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(8): 1091-1100.

图/表 14

参考文献 12

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	Shu X, Zhu Y Z T, Li Y J, et al. Interpretation of expert consensus on anesthesia in enhanced recovery after surgery for esophageal cancer surgery[J]. Medical Journal of West China, 2024, 36(12): 1717-1721.
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Clinical data	SIMLE group (n=103)	CIMLE group (n=94)	McKeown group (n=101)	Statistic value	P value
Gender/n				0.124	0.940
Male	56	50	55
Female	47	44	46
Age/year	63.6±6.2	62.9±6.0	63.2±6.2	0.323	0.724
BMI/(kg·m^-2)	21.8±3.4	21.5±3.2	21.3±3.0	0.629	0.534
Tumor differentiation/n				0.125	0.998
Low	30	28	30
Moderate	58	52	57
High	15	14	14
Tumor location/n				0.265	0.992
Upper	34	30	32
Middle	35	32	34
Lower	34	32	35
Tumor diameter/n				0.536	0.765
<3 cm	65	64	66
3‒5 cm	38	30	35
Pathological type/n				1.086	0.897
Squamous cell carcinoma	49	50	52
Adenocarcinoma	46	38	40
Other	8	6	9
Tumor stage/n				0.172	0.999
Ⅰ	21	20	20
Ⅱ	41	38	41
Ⅲ	41	36	40
Neoadjuvant therapy/n				0.744	0.689
Yes	80	68	75
No	23	26	26
Comorbidity/n
Hypertension	13	10	11	0.232	0.890
Diabetes mellitus	16	13	15	0.114	0.944

Clinical data	SIMLE group (n=103)	CIMLE group (n=94)	McKeown group (n=101)	Statistic value	P value
Gender/n				0.124	0.940
Male	56	50	55
Female	47	44	46
Age/year	63.6±6.2	62.9±6.0	63.2±6.2	0.323	0.724
BMI/(kg·m^-2)	21.8±3.4	21.5±3.2	21.3±3.0	0.629	0.534
Tumor differentiation/n				0.125	0.998
Low	30	28	30
Moderate	58	52	57
High	15	14	14
Tumor location/n				0.265	0.992
Upper	34	30	32
Middle	35	32	34
Lower	34	32	35
Tumor diameter/n				0.536	0.765
<3 cm	65	64	66
3‒5 cm	38	30	35
Pathological type/n				1.086	0.897
Squamous cell carcinoma	49	50	52
Adenocarcinoma	46	38	40
Other	8	6	9
Tumor stage/n				0.172	0.999
Ⅰ	21	20	20
Ⅱ	41	38	41
Ⅲ	41	36	40
Neoadjuvant therapy/n				0.744	0.689
Yes	80	68	75
No	23	26	26
Comorbidity/n
Hypertension	13	10	11	0.232	0.890
Diabetes mellitus	16	13	15	0.114	0.944

Clinical data	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Gender/n			‒	1.000
Male	41	41
Female	34	34
Age/year	63.5±6.1	63.4±6.0	0.102	0.921
BMI/(kg·m^-2)	21.75±3.35	21.68±3.25	0.182	0.856
Tumor differentiation/n			0.485	0.628
Low	22	21
Moderate	42	43
High	11	11
Tumor location/n			0.158	0.924
Upper	25	24
Middle	26	27
Lower	24	24
Tumor diameter/n			0.133	0.715
<3 cm	49	48
3‒5 cm	26	27
Pathological type/n			0.215	0.898
Squamous cell carcinoma	38	37
Adenocarcinoma	31	32
Other	6	6
Tumor stage/n			0.412	0.680
Ⅰ	15	14
Ⅱ	32	33
Ⅲ	28	28
Neoadjuvant therapy/n			0.300	0.584
Yes	58	57
No	17	18
Comorbidity/n			‒	1.000
Hypertension	10	10
Diabetes mellitus	12	11

Clinical data	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Gender/n			‒	1.000
Male	41	41
Female	34	34
Age/year	63.5±6.1	63.4±6.0	0.102	0.921
BMI/(kg·m^-2)	21.75±3.35	21.68±3.25	0.182	0.856
Tumor differentiation/n			0.485	0.628
Low	22	21
Moderate	42	43
High	11	11
Tumor location/n			0.158	0.924
Upper	25	24
Middle	26	27
Lower	24	24
Tumor diameter/n			0.133	0.715
<3 cm	49	48
3‒5 cm	26	27
Pathological type/n			0.215	0.898
Squamous cell carcinoma	38	37
Adenocarcinoma	31	32
Other	6	6
Tumor stage/n			0.412	0.680
Ⅰ	15	14
Ⅱ	32	33
Ⅲ	28	28
Neoadjuvant therapy/n			0.300	0.584
Yes	58	57
No	17	18
Comorbidity/n			‒	1.000
Hypertension	10	10
Diabetes mellitus	12	11

Clinical data	SIMLE group(n=88)	McKeown group (n=88)	Statistic value	P value
Gender/n			‒	1.000
Male	48	48
Female	40	40
Age/year	63.6±6.2	63.3±6.1	0.326	0.745
BMI/(kg·m^-2)	21.82±3.38	21.55±3.10	0.415	0.679
Tumor differentiation/n			0.721	0.471
Low	26	25
Moderate	49	50
High	13	13
Tumor location/n			0.412	0.814
Upper	29	28
Middle	30	31
Lower	29	29
Tumor diameter/n			‒	1.000
<3 cm	57	57
3‒5 cm	31	31
Pathological type/n			0.137	0.934
Squamous cell carcinoma	44	43
Adenocarcinoma	39	40
Other	5	5
Tumor stage/n			0.256	0.798
Ⅰ	18	17
Ⅱ	37	38
Ⅲ	33	33
Neoadjuvant therapy/n			1.000	0.317
Yes	67	65
No	21	23
Comorbidity/n			‒	1.000
Hypertension	11	11
Diabetes mellitus	14	14

不同微创路径下食管癌根治术的临床疗效分析

Analysis of clinical efficacy of radical esophagectomy for esophageal cancer using different minimally invasive approaches

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参考文献 12

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Metrics

Perioperative data	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Operation time/min	90.25±10.37	130.37±10.30	23.8	<0.001
Intraoperative blood loss/mL	38.13±10.21	62.52±10.28	14.6	<0.001
Postoperative hospital stay/d	9.5±2.0	12.5±2.0	9.2	<0.001
Lymph nodes dissected/n	22.3±2.1	21.7±2.1	1.7	0.084
Gastric tube indwelling time/d	5.2±1.8	6.0±2.1	2.5	0.013
Nutrition tube indwelling time/d	13.0±3.5	14.0±2.5	2.0	0.046
Abdominal drainage tube indwelling time/d	4.32±1.15	4.70±1.15	2.0	0.046
Total abdominal drainage volume/mL	160.54±42.36	180.28±45.72	2.7	0.007
Mediastinal drainage tube indwelling time/d	2.86±1.02	3.30±1.14	2.5	0.014
Total mediastinal drainage volume/mL	132.36±38.65	148.72±41.28	2.5	0.013
Complication/n
Pulmonary infection	0	0	‒	‒
Incision infection	1	2	‒	0.092
Hoarseness	1	5	‒	0.236
Anastomotic leakage	1	8	‒	0.036
Anastomotic stricture	1	9	‒	0.024
Chylous leakage	0	1	‒	0.500
Arrhythmia	0	0	‒	‒

Perioperative data	SIMLE group (n=88)	McKeown group (n=88)	Statistic value	P value
Operation time/min	97.42±10.11	154.45±10.22	37.2	<0.001
Intraoperative blood loss/mL	42.53±10.00	82.13±10.42	25.7	<0.001
Postoperative hospital stay/d	9.9±2.1	14.5±2.5	13.2	<0.001
Lymph nodes dissected/n	22.5±2.0	22.0±2.2	1.5	0.116
Gastric tube indwelling time/d	5.5±1.5	7.9±2.5	7.7	<0.001
Nutrition tube indwelling time/d	13.2±3.0	14.5±4.2	2.3	0.019
Abdominal drainage tube indwelling time/d	4.40±1.10	9.16±2.03	19.3	<0.001
Total abdominal drainage volume/mL	162.50±42.00	489.74±126.35	20.0	<0.001
Mediastinal drainage tube indwelling time/d	2.30±1.11	5.75±1.63	16.4	<0.001
Total mediastinal drainage volume/mL	135.54±40.00	210.35±48.41	11.1	<0.001
Complication/n
Pulmonary infection	0	6	‒	0.041
Incision infection	1	3	‒	0.622
Hoarseness	0	6	‒	0.041
Anastomotic leakage	1	10	‒	0.011
Anastomotic stricture	1	12	‒	0.004
Chylous leakage	0	4	‒	0.062
Arrhythmia	0	2	‒	0.249

Variable	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Preoperative
IL-6/(ng·mL^-1)	1.74±0.21	1.72±0.20	0.597	0.550
TNF-α/(ng·mL^-1)	1.04±0.11	1.03±0.12	0.532	0.596
CRP/(mg·L^-1)	2.07±0.20	2.05±0.21	0.597	0.551
Postoperative Day 7
IL-6/(ng·mL^-1)	3.08±0.32	5.05±0.30	38.895	<0.001
TNF-α/(ng·mL^-1)	3.55±0.25	4.78±0.24	30.735	<0.001
CRP/(mg·L^-1)	97.77±34.38	113.24±35.21	2.722	0.007

Variable	SIMLE group (n=88)	McKeown group (n=88)	Statistic value	P value
Preoperative
IL-6/(ng·mL^-1)	1.78±0.21	1.80±0.20	0.647	0.518
TNF-α/(ng·mL^-1)	1.07±0.11	1.10±0.11	1.807	0.072
CRP/(mg·L^-1)	2.10±0.20	2.12±0.22	0.633	0.527
Postoperative Day 7
IL-6/(ng·mL^-1)	3.15±0.30	5.75±0.32	55.604	<0.001
TNF-α/(ng·mL^-1)	3.60±0.28	5.81±0.28	52.355	<0.001
CRP/(mg·L^-1)	105.04±35.14	158.33±38.56	9.582	<0.001

Variable	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Preoperative
Prealbumin/(mg·L^-1)	235.12±47.85	233.45±48.10	0.213	0.832
Albumin/(g·L^-1)	24.48±4.05	24.65±3.98	0.259	0.796
Postoperative Day 14
Prealbumin/(mg·L^-1)	320.45±52.10	302.80±51.65	2.084	0.039
Albumin/(g·L^-1)	35.12±5.20	33.00±4.95	2.557	0.012
Postoperative Month 1
Prealbumin/(mg·L^-1)	346.80±48.50	328.40±47.10	2.357	0.020
Albumin/(g·L^-1)	35.15±5.25	33.05±4.90	2.533	0.012
Postoperative Month 3
Prealbumin/(mg·L^-1)	362.10±43.50	347.80±41.20	2.067	0.041
Albumin/(g·L^-1)	39.15±3.85	37.55±3.70	2.595	0.010

Variable	SIMLE group (n=88)	McKeown group (n=88)	Statistic value	P value
Preoperative
Prealbumin/(mg·L^-1)	234.50±47.20	231.80±49.50	0.371	0.711
Albumin/(g·L^-1)	24.52±4.10	24.61±4.02	0.147	0.883
Postoperative Day 14
Prealbumin/(mg·L^-1)	319.80±53.25	285.40±56.10	4.172	<0.001
Albumin/(g·L^-1)	35.28±5.35	30.85±5.10	5.623	<0.001
Postoperative Month 1
Prealbumin/(mg·L^-1)	348.15±49.20	301.50±53.40	6.027	<0.001
Albumin/(g·L^-1)	35.30±5.30	30.80±5.05	5.766	<0.001
Postoperative Month 3
Prealbumin/(mg·L^-1)	363.50±44.10	314.20±49.50	6.976	<0.001
Albumin/(g·L^-1)	39.30±3.90	34.85±3.65	7.815	<0.001

Variable	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Before anesthesia induction
pH value	7.42±0.03	7.42±0.04	‒	1.000
Glu/(mmol·L^-1)	5.22±0.51	5.15±0.45	0.891	0.374
BE/(mmol·L^-1)	1.52±1.50	1.58±1.25	0.266	0.790
Lac/(mmol·L^-1)	0.88±0.16	0.87±0.14	0.407	0.684
After anesthesia induction
pH value	7.35±0.04	7.31±0.05	0.675	<0.001
Glu/(mmol·L^-1)	7.72±0.86	8.21±1.12	3.005	0.003
BE/(mmol·L^-1)	-0.95±1.42	-1.65±1.90	2.556	0.012
Lac/(mmol·L^-1)	1.42±0.30	1.76±0.42	5.708	<0.001

Variable	SIMLE group (n=88)	McKeown group (n=88)	Statistic value	P value
Before anesthesia induction
pH value	7.41±0.03	7.41±0.05	‒	1.000
Glu/(mmol·L^-1)	5.14±0.48	5.10±0.44	0.576	0.565
BE/(mmol·L^-1)	1.54±1.48	1.62±1.42	0.366	0.715
Lac/(mmol·L^-1)	0.88±0.15	0.89±0.13	0.472	0.637
After anesthesia induction
pH value	7.34±0.04	7.26±0.05	11.720	<0.001
Glu/(mmol·L^-1)	7.75±0.88	8.65±1.18	5.736	<0.001
BE/(mmol·L^-1)	-1.05±1.45	-2.45±1.85	5.587	<0.001
Lac/(mmol·L^-1)	1.45±0.31	2.02±0.60	7.918	<0.001

Variable	SIMLE group (n=75)	CIMLE group (n=75)	Statistic value	P value
Preoperative	129 (122, 135)	128 (121, 134)	‒	1.000
Postoperative Day 1	123 (117, 129)	119 (115, 124)	2.00	0.045
Postoperative Day 7	135 (131, 139)	131 (127, 135)	2.70	0.007
Postoperative Day 14	139 (135, 143)	135 (131, 139)	3.20	0.001
Postoperative Month 1	145 (141, 148)	141 (137, 144)	3.70	<0.001

Variable	SIMLE group (n=88)	McKeown group (n=88)	Statistic value	P value
Preoperative	128 (121, 135)	128 (122, 133)	‒	1.000
Postoperative Day 1	122 (117, 128)	115 (111, 120)	5.86	<0.001
Postoperative Day 7	134 (130, 138)	125 (121, 129)	7.64	<0.001
Postoperative Day 14	138 (134, 142)	129 (125, 133)	7.92	<0.001
Postoperative Month 1	144 (140, 148)	133 (129, 137)	8.49	<0.001

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